Policy and Advocacy Skills for Community-Based Public Health APHA Community-Based Public Health Caucus October 12, 2012 Jenifer J. Martin, J.D.

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1 Policy and Advocacy Skills for Community-Based Public Health APHA Community-Based Public Health Caucus October 12, 2012 Jenifer J. Martin, J.D.

2 Lobbying vs. Advocacy Advocacy efforts are focused on education about an issue and its impact on individuals and communities. Examples: Posting an analysis of a piece of legislation on your website with details on how it will affect the people you work with, or meeting with your Member of Congress to describe the impact of a policy on your community. Lobbying consists of communications that seek to influence policymakers to take a certain position on a specific piece of legislation. Examples: Meeting with a Member of Congress to ask them to cosponsor a specific bill or writing a letter which requests that they vote for or against a specific bill.

3 Federal Restrictions on Lobbying Tax-exempt status determines restrictions on certain lobbying activities (but much of public health advocacy does not qualify) Public Charities v Private Foundations What is lobbying? Direct vs. Grassroots Direct lobbying: Any attempt to influence legislation through communication with legislators, staff persons, or any other government official who participates in the formulation of legislation where the communication (1) refers to specific legislation and (2) reflects a view on the legislation. 26 CFR S (b) Grassroots lobbying: Any attempt to influence any legislation through an attempt to influence the opinions of the general public or any segment thereof. 26 CFR S (b) Must (1) refer to specific legislation, (2) reflect a view on the legislation, and (3) include a call to action.

4 Federal Restrictions on Lobbying How much lobbying is permitted? Substantial Part Test No substantial part of a 501(c)(3) organization s activities may consist of lobbying. Lobbying activities should be limited to approximately 5% of an organization s total efforts. OR Expenditure Test In general, organizations can spend as much as 20% of their entire budget on lobbying. (Note: no federal grant funds can be used for lobbying See OMB Circular No. A-122) See: Center for Lobbying in the Public Interest:

5 Government Relations Role at SPH Objectives: Develop and direct government relations and advocacy strategies to advance the expertise and interests of UMSPH students and faculty among policy stakeholders including the State of Michigan, federal agencies, and the U.S. Congress.

6 Government Relations Role at SPH Advocate for national public health agenda Tailored to reflect UofM projects and centers Translate research into policy to promote informed decisionmaking: specific faculty projects Influence broad policy debates NIH peer-review process, strategic planning Engage the UMSPH Student Body

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10 Case Study: Obesity Overview: Need for type 2 diabetes prevention in African American and Hispanic adolescents Concept of Health Literacy Youth Health Promotion Challenge CBPR project in Detroit, Michigan Use of preliminary findings/publications development of one-pagers and talking points ( tools )

11 Youth Health Promotion Challenge: Using a CBPR approach to address functional health literacy and type 2 diabetes prevention in African American and Latino adolescents Presenters: Melissa A. Valerio, PhD and Gloria Palmisano, MA APHA 138th Annual Meeting & Expo. November 10, 2010, Denver, CO.

12 Health Literacy Ninety million people in the United States have difficulty understanding and using health information. Health Literacy: A Prescription to End Confusion, Institute of Medicine, 2004 "a stronger predictor of a person's health than age, income, employment status, education level, and race" American Medical Association, JAMA, Feb 10, 1999; Gazmararian, 2005; Powell, 2004; Baker, 2006; Schillinger, 2008

13 Summary In this study, 60% of adolescents were at the 85 th percentile or greater for overweight and over 40% read below grade level. Knowledge and understanding of type 2 diabetes and risk factors in adolescent African American and Hispanic populations was limited. CBPR approach: Valuable in promotion of functional health literacy Significant contributor to the design of a more appropriate intervention, successful recruitment and retention Promotion of functional health literacy by engaging in decision making and care management may be a promising approach for addressing health disparities.

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18 Case Study: Obesity State of Michigan In his first State of the State address, Governor Rick Snyder identified obesity as one of two priority areas for his new Administration

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20 Case Study: Obesity First Lady Michelle Obama s Let s Move! America s Move to Raise a Healthier Generation of Kids initiative

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22 Initiative launched February 9, 2010 Four pillars originally created Presidential Executive Order same day Childhood Obesity Task Force Report

23 Let s Move Pillars Empowering Parents and Caregivers Providing Healthy Food in Schools Improving Access to Healthy, Affordable Foods Increasing Physical Activity

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25 Translating Research into Policy: How do we get from here to there?

26 Overall Principles Success is dependent on both substance and relationships This expertise is focused on an understanding of process Broad application to fed/state/local issues There is a right way and a wrong way this world has its own etiquette and protocol It s not rocket science!

27 Step 1: What is your goal?

28 Define Issue and Objective Identify issue/problem Understand all sides of the issue, and all arguments, both pro and con Use your resources to develop a substantive policy position Use research findings to build your argument Take a stand and identify advocacy objective

29 Define Issue and Objective Know that you may not win politics, politics Identify acceptable alternatives anticipate compromise (short/intermediate/long-term) Develop the ask -- draft language Are you being proactive or reactive? Do you want action, or maintain the status quo? Do you want to change current law? Create a new law? Issue Executive Order? Promulgate regulation? Educate policymakers for future activity? (there must be one these people don t have time to chat)

30 Step 2: Who can accomplish your goal?

31 Identify and Understand Target Audience Who is the Decisionmaker? Who influences the Decisionmaker? (media, interest groups, etc) Example: Legislation not the White House! Authorization v. $$$Appropriations$$$ Elected Official v. Staff understand their respective roles in policymaking (MI-term limits!)

32 Identify Resources and Build Coalition of Stakeholders Develop champion to carry the ball for you Constituent Members, Committee jurisdiction, State delegations, Governors, Leadership, Caucuses What are other interested stakeholders doing? Is there an opportunity to build a coalition to achieve your goal?

33 Identify Resources and Build Coalition of Stakeholders Can you include grassroots efforts? Elected officials respond to constituents first Interest groups Trade Associations/Business Related Groups/Unions/Issue Groups/Public Interest Groups/Political Parties Administration: White House/Relevant Agency/Department/OMB/GAO/CBO State agency?

34 Step 3: How will you communicate your goal?

35 Develop Message Reflecting Objective and Audience Message must be crafted in both substantive and political context Do your homework! Be the expert! Understand the players, especially your opposition who is arguing against you, and why? Include arguments refuting the opposition in your message to arm the staff with responses Message might vary for different audiences

36 Step 4: What is the strategy to advance your goal?

37 Develop Strategy to Articulate Message Cultivate personal relationships Conduct in-person meetings Provide testimony in public hearings Hold briefings/participate in town hall meetings Invite staff to come to you visit project, etc Mail Write Letters (reality of post 9-11 security concerns) Grassroots efforts/events Media: op/ed, place articles strategically Participate in campaign activities

38 Advocate Educate and Influence Respect the Etiquette Network to articulate your message (hand out your cards, build your rolodex) Build relationships (eye contact, smiles, firm handshake, use common sense!) Thank you, thank you, thank you

39 Advocate Educate and Influence Respect the Etiquette Admit when you don t know something, and offer to find the answer Integrity, honesty, and respect Understand and be considerate of timing, protocol, competing demands Check your ego at the door

40 Advocate Educate and Influence Respect the Protocol Who else needs to know what you re doing? (avoid surprises) Be brief, concise, and to the point! (8 minute rule) Tools of the trade do the work for them and speak their language: the leave-behind one-pager white paper policy brief fact sheet Supplement with other compelling documents (NYT editorials, research findings, etc)

41 Meeting Essentials Thank you for taking the time to meet with me today. Introduce yourself, the organization you represent, and identify the reason for the visit (i.e., specific bill) Explain why they should care about your issue (constituent issue, they are a member of a relevant committee with an upcoming vote, etc.) Provide information, and address opposing points of view to arm them with answers to likely questions. Offer to serve as a resource and provide followup information.

42 *Followup* This is critical! Write thank you notes! Get personal stationery and use it! (For Hill staff, be aware of security issues, so use ) Offer your assistance, serve as a resource, answer questions, provide information Maintain contact and stay in touch

43 Advocacy Checklist What is the problem? (Define Issue) What do you want to do about it? (Identify Objective) Include short, intermediate, and long-term goals Include acceptable compromises Who is the decisionmaker? (Identify and Understand Target Audience (s) Including who influences decisionmaker (relevant media) Who can help you achieve your goal (Champion), and who will oppose your efforts? (Identify Resources and Stakeholders) (Internal and external/build coalition/champion/allies/opponents) What s your message? (Be Aware of Political Context) How will you communicate it? (Develop Strategy) (Conduct meetings, write letters, coordinate direct mail campaigns, promote media, grassroots efforts, etc) Get it Done Advocate to Implement Strategy Followup to Maintain Relationships and Build Trust

44 Questions? Room 1762, SPH I